New technique TEES up advance in otologic surgery


Dr. Brandon Isaacson performs an inner-ear surgery using the minimally invasive TEES technique. Over the past two years, Dr. Icaacson has performed about 400 TEES procedures, making UTSW one of the country's leaders in the technique.
There’s been a push in recent years toward minimally invasive surgery where possible. But until recently, there hasn’t been a minimally invasive option available in the U.S. for middle- and inner-ear surgery.

Brandon Isaacson, M.D., is one of a group of physicians hoping to change that. Dr. Isaacson, Associate Professor of Otolaryngology-Head and Neck Surgery and Co-Director of the Comprehensive Skull Base Program at UT Southwestern, has pioneered the use of transcanal endoscopic ear surgery, or TEES. This technique provides minimally invasive surgical access to the middle and inner ear and direct visualization of the surgical area.

This is the leading edge of advancements in technology for such surgeries, according to Bradley Marple, M.D., Professor and Chair of Otolaryngology-Head and Neck Surgery. Others from the department who are specialists in the technique include J. Walter Kutz Jr., M.D., and Jacob Hunter, M.D.

‘Unparalleled visualization’

For the past six decades, ear surgeons have been limited to using microscopes for visualization during surgery. During a traditional ear surgery, the surgeon makes an incision behind the ear, brings the ear forward, and either works from behind the ear canal or opens the mastoid bone.

But TEES could transform the practice for physicians and patients. “It’s unparalleled visualization of places in the ear that we’ve really not been able to see that well before,” Dr. Isaacson says. “One of the problems with chronic ear disease and tumors in the ear is that there is not a straight-line view in many areas. Traditionally, you had to remove a lot more bone to see and adequately address disease.”

Clinical applications of TEES

Dr. Isaacson has performed approximately 400 TEES procedures for patients in North Texas since spring 2014. Some of the procedures he’s completed using the TEES approach include:

  • Myringoplasty
  • Tympanoplasty
  • Canaloplasty
  • Ossicular chain reconstruction
  • Congenital conductive hearing loss reconstruction
  • Stapedectomy
  • Removal of cholesteatoma
  • Removal and grafting of facial nerve tumors
  • Removal of acoustic neuromas (a procedure that previously had been completed only in Italy)
  • Removal of glomus tympanicum
  • Repair of cerebrospinal fluid otorrhea, or a leakage of cerebrospinal fluid through the ear
In a short time, UT Southwestern has become what Dr. Isaacson calls “one of the leading centers in the country” to offer TEES. Dr. Isaacson is a member of the International Working Group on Endoscopic Ear Surgery (IWGEES), which promotes the technique internationally and teaches it to interested surgeons.

Continued study and development

Research on the applications of TEES continues, Dr. Marple notes. “How do we actually create the procedures and the access to be able to visualize and work in such a small space?” he asks. “And then there’s clinical research that’s generated from that, which is starting simply – how do we accomplish the various surgical procedures? And then, incrementally, the boundaries of what can be done start to expand.”

Dr. Isaacson points out that UT Southwestern soon will be comparing traditional techniques for otologic surgery to endoscopic techniques looking at postoperative pain and recovery. He has high hopes for the expansion and adoption of TEES.

“Endoscopic surgery is the next new thing,” Dr. Isaacson says. “And we think that it’s going to, hopefully, lead to better outcomes – not only with patient satisfaction but also with addressing disease that we haven’t been able to easily address in the past.”

To refer a patient for a TEES evaluation, call 214-645-8300.

To watch a video of Dr. Isaacson demonstrating various TEES procedures, visit the Otologic Surgery YouTube channel.

Physician Referral Information

UT Southwestern physicians offer consultations and treatment in more than 60 subspecialties. Recognizing that navigating through the many programs and resources at UT Southwestern can be challenging, the University established Patient and Physician Referral Services to assist external physicians and their staff with securing patient appointments. Offices may call one centralized phone number to schedule a consultation in any clinic or to fax patient records related to a referral. The UT Southwestern referral coordinator will work closely with the appropriate physician or clinic to coordinate the patient’s appointment, as well as contact the patient and referring physician’s office with the appointment details.

Call a coordinator today at 214-645-8300.